Long-term clinical outcomes of papillary thyroid carcinoma patients with biochemical incomplete response

• Published in: Endocrine Vol. 67; no. 3; pp. 623 - 629
• Main Authors: Ahn, Jonghwa, Song, Eyun, Kim, Won Gu, Kim, Tae Yong, Kim, Won Bae, Shong, Young Kee, Jeon, Min Ji
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2020; Springer Nature B.V
• Subjects: Clinical outcomes; Diabetes; Endocrinology; Humanities and Social Sciences; Internal Medicine; Iodine; Medicine; Medicine & Public Health; multidisciplinary; Original Article; Papillary thyroid carcinoma; Risk factors; Science; Thyroglobulin; Thyroid; Thyroid cancer; Thyroidectomy; Dynamic risk stratification; Biochemical incomplete response; Prognosis; Papillary thyroid carcinoma
• ISSN: 1355-008X; 1559-0100
• DOI: 10.1007/s12020-019-02142-1

Purpose The aim of this study was to evaluate the long-term clinical outcomes of papillary thyroid carcinoma (PTC) patients exhibiting biochemical incomplete response (BIR) to initial therapy. Methods We evaluated 102 patients with PTC showing a BIR during the first 12–24 months after total thyroidectomy and radioactive iodine therapy. Patients were divided into three groups according to changes in stimulated thyroglobulin (Tg) and anti-Tg antibody (TgAb) levels: the increasing TgAb group ( n  = 19, 18.6%), the decreasing Tg group ( n  = 58, 56.9%), and the increasing Tg group ( n  = 25, 24.5%). Results With a median follow-up of 12 years, 43 (42%) patients had structural persistent disease as follows: 36 (84%) at regional sites and 7 (16%) at distant sites. The rate of structural persistent disease was significantly different between groups, with 21%, 41%, and 60% in the increasing TgAb, decreasing Tg, and increasing Tg groups, respectively ( P  = 0.012). Among patients without structural persistent disease, only 19 (18.6%) showed no evidence of disease and 40 (39.2%) were of a biochemical persistent status at the time of final follow-up. Increasing Tg after initial therapy was a significant risk factor for structural persistent disease in patients with BIR (HR, 4.16; 95% confidence interval (CI): 1.38 – 12.54, P  = 0.011). Conclusions PTC patients with BIR showed a high rate of structural persistent disease and Tg change after initial therapy is the most important prognostic factor for determining clinical outcomes of these patients.